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Wang H, Li J, Chen J, Li M, Liu J, Wei L, Zeng Q. Multi-parameter MRI-Based Machine Learning Model to Evaluate the Efficacy of STA-MCA Bypass Surgery for Moyamoya Disease: A Pilot Study. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01130-w. [PMID: 39020152 DOI: 10.1007/s10278-024-01130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 07/19/2024]
Abstract
Superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery represents the primary treatment for Moyamoya disease (MMD), with its efficacy contingent upon collateral vessel development. This study aimed to develop and validate a machine learning (ML) model for the non-invasive assessment of STA-MCA bypass surgery efficacy in MMD. This study enrolled 118 MMD patients undergoing STA-MCA bypass surgery. Clinical features were screened to construct a clinical model. MRI features were extracted from the middle cerebral artery supply area using 3D Slicer and employed to build five ML models using logistic regression algorithm. The combined model was developed by integrating the radiomics score (Rad-score) with the clinical features. Model performance validation was conducted using ROC curves. Platelet count (PLT) was identified as a significant clinical feature for constructing the clinical model. A total of 3404 features (851 × 4) were extracted, and 15 optimal features were selected from each MRI sequence as predictive factors. Multivariable logistic regression identified PLT and Rad-score as independent parameters used for constructing the combined model. In the testing set, the AUC of the T1WI ML model [0.84 (95% CI, 0.70-0.97)] was higher than that of the clinical model [0.66 (95% CI, 0.46-0.86)] and the combined model [0.80 (95% CI, 0.66-0.95)]. The T1WI ML model can be used to assess the postoperative efficacy of STA-MCA bypass surgery for MMD.
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Affiliation(s)
- Huaizhen Wang
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jizhen Li
- Department of Radiology, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, China
| | - Jinming Chen
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong University, Jinan, Shandong, China
| | - Meilin Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jiahao Liu
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Lingzhen Wei
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Clinical Medicine, Jining Medical University, Jining, 27206, Shandong, China
| | - Qingshi Zeng
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
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Lee K, Perry K, Xu M, Veillard I, Kumar R, Rao TD, Rueda BR, Spriggs DR, Yeku OO. Structural basis for antibody recognition of the proximal MUC16 ectodomain. J Ovarian Res 2024; 17:41. [PMID: 38374055 PMCID: PMC10875768 DOI: 10.1186/s13048-024-01373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Mucin 16 (MUC16) overexpression is linked with cancer progression, metastasis, and therapy resistance in high grade serous ovarian cancer and other malignancies. The cleavage of MUC16 forms independent bimodular fragments, the shed tandem repeat sequence which circulates as a protein bearing the ovarian cancer biomarker (CA125) and a proximal membrane-bound component which is critical in MUC16 oncogenic behavior. A humanized, high affinity antibody targeting the proximal ectodomain represents a potential therapeutic agent against MUC16 with lower antigenic potential and restricted human tissue expression. RESULTS Here, we demonstrate the potential therapeutic versatility of the humanized antibody as a monoclonal antibody, antibody drug conjugate, and chimeric antigen receptor. We report the crystal structures of 4H11-scFv, derived from an antibody specifically targeting the MUC16 C-terminal region, alone and in complex with a 26-amino acid MUC16 segment resolved at 2.36 Å and 2.47 Å resolution, respectively. The scFv forms a robust interaction with an epitope consisting of two consecutive β-turns and a β-hairpin stabilized by 2 hydrogen bonds. The VH-VL interface within the 4H11-scFv is stabilized through an intricate network of 11 hydrogen bonds and a cation-π interaction. CONCLUSIONS Together, our studies offer insight into antibody-MUC16 ectodomain interaction and advance our ability to design agents with potentially improved therapeutic properties over anti-CA125 moiety antibodies.
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Affiliation(s)
- Kwangkook Lee
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Kay Perry
- Department of Chemistry and Chemical Biology, Argonne National Laboratory, NE-CAT, Cornell University, Building 436E, 9700 S. Cass Avenue, Argonne, IL, 60439, USA
| | - Mengyao Xu
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Irva Veillard
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Raj Kumar
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Thapi Dharma Rao
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Bo R Rueda
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - David R Spriggs
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
| | - Oladapo O Yeku
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
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Treffalls RN, Poe K, Abdou H, Stonko DP, Edwards J, DeMartino RR, Ptak T, Morrison JJ. Exploring Intra-arterial Contrast Administration for Intraoperative Imaging Using a Swine Model. Angiology 2023:33197231155225. [PMID: 36753679 DOI: 10.1177/00033197231155225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Intraoperative computed tomography (CT) imaging with endovascular delivery of intra-arterial (IA) contrast could potentially provide higher attenuation with lower contrast volumes than intravenous (IV) administration. We aimed to compare IA and IV contrast use for organ-specific CT abdominal imaging. Five anesthetized swine had external jugular and brachial artery access with ascending aortic pigtail placement. An IV protocol was 100 mL at 5 mL/sec over 20 sec vs 50 mL of IA contrast at 5 mL/sec over 10 sec. Region-of-interest markers were applied to anatomical regions to measure attenuation (HU) over time. IA and IV contrast protocols achieved adequate aortic opacification (IA, 455 ± 289 vs IV, 450 ± 114 HU). The IA contrast aortic attenuation curve reached peak attenuation compared with IV contrast (IA, 8 vs 23 sec; P < .001). Time to peak attenuation was similar between IA and IV contrast in the portal vein (IA, 38 vs IV, 42 sec, P = .25). IA administration achieved a superior contrast-to-noise ratio (CNR) in less time compared with IV (R2 = .94; P < .001). IA contrast achieved adequate opacification with less bolus broadening and a superior CNR compared with IV contrast while using a smaller contrast volume for directed organ-directed imaging.
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Affiliation(s)
- Rebecca N Treffalls
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Kelly Poe
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Hossam Abdou
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - David P Stonko
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
- Department of Surgery, 160877The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Edwards
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Randall R DeMartino
- 314374Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Thomas Ptak
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Jonathan J Morrison
- 314374Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Kato N, Kan I, Abe Y, Otani K, Narikiyo M, Nagayama G, Nishimura K, Mori R, Kodama T, Ishibashi T, Murayama Y. Visualization of extracranial-intracranial bypass in moyamoya patients using intraoperative three-dimensional digital subtraction angiography with intravenous contrast injection and robotic C-arm: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2057. [PMID: 36131586 PMCID: PMC9628098 DOI: 10.3171/case2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND The authors describe a noninvasive intraoperative imaging strategy of three-dimensional (3D) digital subtraction angiography (DSA) with intravenous (IV) contrast injection, using indocyanine green (ICG) as a test bolus, during extracranial-intracranial (EC-IC) bypass surgery for moyamoya disease. OBSERVATIONS Four patients underwent EC-IC bypass surgery in a hybrid operating room. During the surgery, bypass patency was verified using ICG videoangiography and Doppler ultrasonography. After skin closure, the patients under anesthesia underwent IV 3D-DSA with a robotic C-arm in which the scan delay time for the 3D-DSA scan was estimated from the arrival time of ICG during the ICG videoangiography. One day after the surgery, the patients underwent magnetic resonance angiography (MRA). The IV 3D-DSA images were retrospectively compared with those obtained with other modalities. Good bypass patency was confirmed on IV 3D-DSA, ICG videoangiography, Doppler ultrasonography, and postoperative MRA in all cases. The delay time determined using ICG videoangiography as a test bolus resulted in IV 3D-DSA with adequate image quality, allowing assessment of the spatial relationships between the vessels and anastomoses from all directions. LESSONS To evaluate bypass patency and anatomical relationships immediately after EC-IC bypass surgery, IV 3D-DSA may be a useful modality. ICG videoangiography can be used to determine the scan delay time.
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Affiliation(s)
- Naoki Kato
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Yukiko Abe
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | - Katharina Otani
- Siemens Healthcare K.K., Advanced Therapies Innovation Department, Tokyo, Japan; and
| | - Michihisa Narikiyo
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Gota Nagayama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Kengo Nishimura
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Ryosuke Mori
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Tomonobu Kodama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
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Caton MT, Wiggins WF, Nunez D. Three‐Dimensional Cinematic Rendering to Optimize Visualization of Cerebrovascular Anatomy and Disease in CT Angiography. J Neuroimaging 2020; 30:286-296. [DOI: 10.1111/jon.12697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- M. Travis Caton
- Department of RadiologyBrigham and Women's Hospital Boston MA
- Harvard Medical SchoolHarvard University Boston MA
| | - Walter F. Wiggins
- Department of RadiologyBrigham and Women's Hospital Boston MA
- Harvard Medical SchoolHarvard University Boston MA
| | - Diego Nunez
- Department of RadiologyBrigham and Women's Hospital Boston MA
- Harvard Medical SchoolHarvard University Boston MA
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Computed tomography perfusion evaluation after extracranial–intracranial bypass surgery. Clin Neurol Neurosurg 2015. [DOI: 10.1016/j.clineuro.2015.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Carotid occlusion is a disease that presents a difficult decision for the treating provider. Traditionally, many providers would opt for expectant management with risk factor reduction and supportive therapy. There is a growing body of literature however pointing to possible improved outcomes of more aggressive treatments, including reopening of the occluded carotid. In this review, we discuss the difficulties involved in diagnosing a patient presenting with symptomatic carotid occlusion, the natural history of the disease, and the emerging treatment options and paradigms of different institutions based on recent literature.
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Serrone JC, Jimenez L, Hanseman DJ, Carroll CP, Grossman AW, Wang L, Vagal A, Choutka O, Andaluz N, Ringer AJ, Abruzzo T, Zuccarello M. Changes in computed tomography perfusion parameters after superficial temporal artery to middle cerebral artery bypass: an analysis of 29 cases. J Neurol Surg B Skull Base 2014; 75:371-7. [PMID: 25452893 DOI: 10.1055/s-0034-1373658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 02/23/2014] [Indexed: 10/25/2022] Open
Abstract
Introduction Analysis of computed tomography perfusion (CTP) studies before and after superficial temporal artery to middle cerebral artery (STA-MCA) bypass is warranted to better understand cerebral steno-occlusive pathology. Methods Retrospective review was performed of STA-MCA bypass patients with steno-occlusive disease with CTP before and after surgery. CTP parameters were evaluated for change after STA-MCA bypass. Results A total of 29 hemispheres were bypassed in 23 patients. After STA-MCA bypass, mean transit time (MTT) and time to peak (TTP) improved. When analyzed as a ratio to the contralateral hemisphere, MTT, TTP, and cerebral blood flow (CBF) improved. There was no effect of gender, double vessel versus single vessel bypass, or time until postoperative CTP study to changes in CTP parameters after bypass. Conclusions Blood flow augmentation after STA-MCA bypass may best be assessed by CTP using baseline MTT or TTP and ratios of MTT, TTP, or CBF to the contralateral hemisphere. The failure of cerebrovascular reserve to improve after cerebral bypass may indicate irreversible loss of autoregulation with chronic cerebral vasodilation or the inability of CTP to detect these improvements.
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Affiliation(s)
- Joseph C Serrone
- Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States
| | - Lincoln Jimenez
- Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States
| | - Dennis J Hanseman
- Department of Surgery, Division of Trauma/Critical Care, University of Cincinnati, Cincinnati, Ohio, United States
| | - Christopher P Carroll
- Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States
| | - Aaron W Grossman
- Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States ; Comprehensive Stroke Center at the UC Neuroscience Institute, Cincinnati, Ohio, United States
| | - Lily Wang
- Department Radiology, University of Cincinnati, Ohio, United States
| | - Achala Vagal
- Department Radiology, University of Cincinnati, Ohio, United States
| | - Ondrej Choutka
- Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States
| | - Norberto Andaluz
- Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States ; Comprehensive Stroke Center at the UC Neuroscience Institute, Cincinnati, Ohio, United States ; Mayfield Clinic, Cincinnati, Ohio, United States
| | - Andrew J Ringer
- Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States ; Comprehensive Stroke Center at the UC Neuroscience Institute, Cincinnati, Ohio, United States ; Mayfield Clinic, Cincinnati, Ohio, United States
| | - Todd Abruzzo
- Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States ; Comprehensive Stroke Center at the UC Neuroscience Institute, Cincinnati, Ohio, United States ; Department Radiology, University of Cincinnati, Ohio, United States ; Mayfield Clinic, Cincinnati, Ohio, United States
| | - Mario Zuccarello
- Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States ; Comprehensive Stroke Center at the UC Neuroscience Institute, Cincinnati, Ohio, United States ; Mayfield Clinic, Cincinnati, Ohio, United States
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Imaging after direct and indirect extracranial-intracranial bypass surgery. AJR Am J Roentgenol 2013; 201:W124-32. [PMID: 23789684 DOI: 10.2214/ajr.12.9517] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the imaging features of different types of surgical cerebral revascularization techniques. CONCLUSION Surgical cerebral revascularization involves direct and indirect techniques. Direct revascularization entails anastomosing a branch of the external carotid artery to a cerebral artery. Indirect revascularization involves delivering an extracranial vascular supply in proximity to the surface of the brain. The results of these techniques have distinctive imaging features.
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Tsuchiya K, Imai M, Nitatori T, Kimura T. Postoperative evaluation of superficial temporal artery-middle cerebral artery bypass using an MR angiography technique with combined white-blood and black-blood sequences. J Magn Reson Imaging 2013; 38:671-6. [DOI: 10.1002/jmri.24019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 12/05/2012] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kazuhiro Tsuchiya
- Department of Radiology; Kyorin University Faculty of Medicine; Shinkawa, Mitaka, Tokyo; Japan
| | - Masamichi Imai
- Department of Radiology; Kyorin University Faculty of Medicine; Shinkawa, Mitaka, Tokyo; Japan
| | - Toshiaki Nitatori
- Department of Radiology; Kyorin University Faculty of Medicine; Shinkawa, Mitaka, Tokyo; Japan
| | - Tokunori Kimura
- Toshiba Medical Systems; Shimoishigami, Otawara, Tochigi; Japan
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Quantification of blood flow in internal cerebral artery by optical flow method on digital subtraction angiography in comparison with time-of-flight magnetic resonance angiography. PLoS One 2013; 8:e54678. [PMID: 23358555 PMCID: PMC3554643 DOI: 10.1371/journal.pone.0054678] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/13/2012] [Indexed: 11/19/2022] Open
Abstract
Objective This study compared data on the blood flow velocity in the internal carotid artery, which was obtained using the optical flow method (OFM) with digital subtraction angiography (DSA) and the time-of-flight (TOF) technique using magnetic resonance angiography (MRA). Materials and Methods Images were obtained from 12 cerebrovascular patients who underwent both brain DSA and MRA imaging. The OFM was applied on the DSA images to determine the average blood flow velocity. The calculated results were compared with the values obtained from the TOF-MRA data. A linear fit was performed on the data and Bland-Altman plots were analyzed. Results The blood flow velocity was closely associated with vascular diseases. Color-coding of the OFM measurements were superimposed on to the DSA images, which quantitatively illustrated the relative flow in the vessels. The average blood flow velocity was calculated using OFM and DSA, which demonstrated a high correlation with the MRA measurements in the anterior-posterior (AP) view (R = 0.71). In contrast, the average blood flow velocity was low in the lateral view (R = 0.28). The consistency between the high and low blood velocity in the AP view was better compared to the lateral view. The blood flow velocity distribution in the AP view was statistically closer to the MRA measurement compared to the lateral view. Conclusions This study evaluated the correlation of blood flow measured using DSA and TOF-MRA in a small heterogeneous group of patients with cerebrovascular lesions. OFM with DSA imaging reveals hemodynamic information and TOF-MRA.
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Gu Y, Ni W, Jiang H, Ning G, Xu B, Tian Y, Xu F, Liao Y, Song D, Mao Y. Efficacy of extracranial–intracranial revascularization for non-moyamoya steno-occlusive cerebrovascular disease in a series of 66 patients. J Clin Neurosci 2012; 19:1408-15. [DOI: 10.1016/j.jocn.2011.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 11/11/2011] [Accepted: 11/11/2011] [Indexed: 11/26/2022]
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